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In our study of fluids we examine quantitatively the circulation of blood in the body buy gasex 100caps free shipping. The theory of fluids allows us also to calculate the role of diffusion in the functioning of cells and the effect of surface tension on the growth of plants in soil purchase 100 caps gasex otc. Using the principles of electricity buy discount gasex 100caps on line, we analyze quantitatively the conduction of impulses along the nervous system. There are, of course, severe limits on the quantitative application of physics to biological systems. Many of the advances in the life sciences have been greatly aided by the application of the techniques of physics and engineering to the study of living systems. Both in common use and in the sci- entific literature one often finds pressure also expressed in units of dynes/cm2, Torr (mm Hg), psi, and atm. In those cases conversion factors have been provided either within the text or in a compilation at the end of Appendix A. Hobbie and David Cinabro for their careful reading of the manuscript and helpful suggestions. In this third edition I want to express my appreciation for the encouragement and compe- tent direction of Tom Singer and Jason Malley editors at Elsevier/Academic Press and for the help of Sarah Hajduk and Ramesh Gurusubramanian in the production of this edition. It was the first branch of physics that was applied success- fully to living systems, primarily to understanding the principles governing the movement of animals. Our present concepts of mechanics were formulated by Isaac Newton, whose major work on mechanics, Principia Mathematica, was published in 1687. The early Greeks, who were interested in both science and athletics, were also the first to apply physical principles to animal movements. Aristotle wrote, “The animal that moves makes its change of position by pressing against that which is beneath it. Runners run faster if they swing their arms for in extension of the arms there is a kind of leaning upon the hands and the wrist. After the decline of ancient Greece, the pursuit of all scientific work entered a period of lull that lasted until the Renaissance brought about a resurgence in many activities including science. During this period of revival, Leonardo da Vinci (1452–1519) made detailed observations of ani- mal motions and muscle functions. Since da Vinci, hundreds of people have contributed to our understanding of animal motion in terms of mechanical principles. Their studies have been aided by improved analytic techniques and the development of instruments such as the photographic camera and electronic timers. Today the study of human motion is part of the disciplines 1 2 Chapter 1 Static Forces of kinesiology, which studies human motion primarily as applied to athletic activities, and biomechanics, a broader area that is concerned not only with muscle movement but also with the physical behavior of bones and organs such as the lungs and the heart. The development of prosthetic devices such as artificial limbs and mechanical hearts is an active area of biomechanical research. Mechanics, like every other subject in science, starts with a certain number of basic concepts and then supplies the rules by which they are interrelated. Appendix A summarizes the basic concepts in mechanics, providing a review rather than a thorough treatment of the subject. We will now begin our dis- cussion of mechanics by examining static forces that act on the human body. We will first discuss stability and equilibrium of the human body, and then we will calculate the forces exerted by the skeletal muscles on various parts of the body. This weight can be considered a force acting through a single point called the center of mass or center of gravity. As pointed out in Appendix A, a body is in static equilibrium if the vectorial sum of both the forces and the torques acting on the body is zero. If a body is unsupported, the force of gravity accelerates it, and the body is not in equilibrium. The position of the center of mass with respect to the base of support deter- mines whether the body is stable or not. A body is in stable equilibrium under the action of gravity if its center of mass is directly over its base of support (Fig. Under this condition, the reaction force at the base of support can- cels the force of gravity and the torque produced by it. If the center of mass is outside the base, the torque produced by the weight tends to topple the body (Fig. The wider the base on which the body rests, the more stable it is; that is, the more difficult it is to topple it. The same amount of angular displacement of a narrow-based body results in a torque that will topple it (Fig. Similar considerations show that a body is more stable if its center of gravity is closer to its base. The act of balancing requires maintenance of the center of gravity above the feet. A person falls when his center of gravity is displaced beyond the position of the feet. When carrying an uneven load, the body tends to compensate by bend- ing and extending the limbs so as to shift the center of gravity back over the feet. This tendency of the body to compensate for uneven weight distribution often causes problems for people who have lost an arm, as the continuous compen- satory bending of the torso can result in a permanent distortion of the spine. It is often recommended that amputees wear an artificial arm, even if they cannot use it, to restore balanced weight distribution. Let us calculate the magnitude of the force applied to the shoulder that will topple a person standing at rigid attention. In the absence of the force, the person is in stable equilibrium because his center of mass is above his feet, which are Section 1. When the person topples, he will do so by pivoting around point A—assuming that he does not slide. The counterclockwise torque Ta about this point produced by the applied force is Ta Fa × 1. The person is on the verge of toppling when the magnitudes of these two torques are just equal; that is, Ta Tw or Fa × 1. This shifts the center of gravity away from the pivot point A, increasing the restoring torque produced by the weight of the body. Stability against a toppling force is also increased by spreading the legs, as shown in Fig. The tendons, which are made of strong tissue, grow into the bone and attach the muscle to the bone. But some muscles end in two or three tendons; these muscles are called, respectively, biceps and triceps. In general, the two bones attached by muscles are free to move with respect to each other at the joints where they contact each other. This arrangement of muscle and bone was noted by Leonardo da Vinci, who wrote, “The muscles always begin and end in the bones that touch one another, and they never begin and end on the same bone.... When fibers in the muscle receive an electrical stimulus from the nerve endings that are attached to them, they contract. This results in a shortening of the muscle and a corresponding pulling force on the two bones to which the muscle is attached. The force of contraction at any time is determined by the number of individual fibers that are contracting within the muscle. When an individual fiber receives an electrical stimulus, it tends to contract to its full ability. If a stronger pulling force is required, a larger number of fibers are stimulated to contract. Experiments have shown that the maximum force a muscle is capable of exerting is proportional to its cross section. From measurements, it has been estimated that a muscle can exert a force of about 7 × 106 dyn/cm2 of its area (7 × 106 dyn/cm2 7 × 105 Pa 102 lb/in2). To compute the forces exerted by muscles, the various joints in the body can be conveniently analyzed in terms of levers. We will assume that the tendons are connected to the bones at well-defined points and that the joints are frictionless. Simplifications are often necessary to calculate the behavior of systems in the real world. Seldom are all the properties of the system known, and even when they are known, consideration of all the details is usually not necessary. Calculations are most often based on a model, which is assumed to be a good representation of the real situation.

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Gentamicin is isolated from Micromonospora purpurea 100caps gasex amex, and it consists of a mixture of approximately equal amounts of three compounds: gentamicines C1 buy gasex 100caps without a prescription,C1a gasex 100caps low price, and C2. Netilmicin is a semisynthetic derivative of schizomycin, which is isolated from Micromonospora inyoensis. The common element in the process leading to the lethal outcome of bacteria is the active transfer of the drug from the surrounding medium into the bacterial cell, which leads to a large accumulation of medicine inside the cell exceeding that of the surroundings. Aminoglycosides easily diffuse through the outer membrane of the bacteria and enter the periplasmic space. The initial intracellular region of aminoglycoside action is the bacterial ribosome. There is evidently a minimum of two different types of ribosomal binding: one is specific to streptomycin, and the other acts by binding with other aminoglycosides. Other aminoglycosides bind to different regions of 30 S and 50 S ribosomal subunits, and cannot compete with streptomycin for binding with 30 S ribosomes. However, none of these effects fully explains the bactericidal effect of aminoglycosides. Aminoglycosides are drugs used predominantly against aerobic and a few Gram-negative microorganisms, S. Bacterial resistance with respect to aminoglycosides can be explained by changes in binding regions on ribosomes, decline in intracellular transport, and deactivation of drugs by microbial enzymes. A change in this protein as a result of a mutation makes the ribosomes unable to bind with strepto- mycin, which makes the organism resistant. Gentamicin, tobramycin, netilmicin, and amikacin bind with many regions on both subunits of the ribosomes, and therefore mutational resistance to them is not common. The second mechanism of resistance makes transport into the cell more difficult, which leads to resistance to all aminoglycosides. This type of resistance is not common among Gram-negative, aerobic, and a few other microorganisms. Since the transport of amino- glycosides through the cytoplasmic membrane is an oxygen-requiring process, anaerobic bacteria always exhibit resistance with respect to these bacteria. The most important mechanism of resistance is the enzyme production by plasmids, which phosphorylate, adenylate, or acetylate specific amino or hydroxyl groups in the aminoglycoside molecules. As soon as the drug passes through the outer membrane and reaches the perplasmic space, it undergoes a change by enzymes. The altered drug (along with the unchanged drug) competes for entrance into the cell, but it turns out that they are unable to bind with ribosomes. In turn, amino- glycosides differ in terms of their ability to resist enzymatic inactivation. Gentamicin, tobramycin, netilmicin, and amikacin are effective in treating aerobic infections and other Gram-negative bacilli. Streptomycin is the drug of choice for treating rabbit fever, plague, and brucellosis (in combination with tetracycline ). It is not used for treating other Gram-negative bacterial infections because of the high likelihood of developing resistance, which can develop as a result of only one mutation. However, it should be especially noted that practically all antibiotics of the aminoglycoside series are not metabolized in the body, but build up in the kidneys and have a certain oto- and nephrotoxicity. It is effective with respect to most Gram-negative and a few Gram-positive bacteria; staphylococci, streptococci, pneu- mococci, gonococci, meningococci, stimulus of dysentery, brucellosis, tuberculosis, rabbit fever, plague, and others. It is used for various diseases caused by microorganisms that are sensitive to it in bacterial endocarditis, periotonitis, meningitis, infections of the urinary tract, gastric infections, and so on. Neomycin: Neomycin is a complex mixture of antibiotics (neomycins A, B, C, D, E, and F), that is formed by the actinomycete S. Neomycin A, also called neamine, is 2-deoxy-4-O-(2,6-diamino-2,6-dideoxy-α-D-glucopyranosyl)-D-streptamine (32. At the same time, neomycin B, O-2,6-diamino- 2,6-dideoxy-α-D-glucopyranosyl(1→4)-O-[O-2,6-diamino-2,6-dideeoxy-β-L-idopyra- nosyl-(1→3)-β-D-ribofuranosyl-(1→5)]-2-deoxy-D-streptamine (32. It is effective with respect to the majority of Gram-negative and a few Gram-positive bacteria; staphylo- cocci, pneumococci, gonococci, meningococci, and stimulants of dysentery. The antibiotic effect of neomycin with respect to many types of bacteria is higher than that of streptomycin. At the same time, microorganisms sensitive to neomycin become resistant to a lesser degree than streptomycin. It is used for various gastrointestinal diseases caused by microorganisms sensitive to it, including enteritis, which is caused by microbes that are resistant to antibiotics. However, because of its high oto- and nephrotoxicity, its local use is preferred for infected skin dis- eases, infected wounds, conjunctivitis, keratitis, and others. Paromomycin: From a chemical point of view, paromomycin, O-2-amino-2-deoxy-α- D-glucopyranosyl(1→4)-O-[O-2,6-diamino-2,6-dideoxy-β-L-idopyranoxyl-(1→3)-β-D- ribofuranosyl-(1→5)]-2-deoxy-D-streptamine (32. In addition, it is recommended for treating severe and chronic forms of gastric amebiasis. Synonyms of this drug are aminosidine, catenulin, crestomycin, hydroxymycin, monomycin, zygomycyn, and others. It is active with respect to most Gram-positive as well as Gram-negative microorganisms (staphylococci, gastric bacilli, rabbit fever, Fridlender’s bacillus, proteus, shigella, salmonella). It is used for treating sepsis, meningitis, osteomyelitis, periotonitis, pneumonia, pyelonephritis, pyelocystitis, infected wounds, and post-operational purulent complica- tions caused by microorganisms sensitive to the drug. Antibiotics It is used for severe bacterial infections: peritonitis, sepsis, meningitis, osteomyelitis, endocarditis, pneumonia, pleural empyema, pulmonary abscess, purulent skin infections and soft tissue infections, and infections of the urinary tract caused by microorganisms that are sensitive to the drug. Gentamicin: Gentamicin is a complex of antibiotics isolated from a culture liquid of the actinomycete M. It is used for pyelonephritis, cystitis, pneumonia, pleural empyema, peritonitis, sepsis, meningitis, purulent skin and soft tissue infections, infected wounds, burns, and so on, which are caused by microorganisms that are sensitive to the drug. Gentamicin is the drug of choice for severe bacterial infections caused by undetermined stimuli. The primary amino group in this molecule is previously protected by acylating it with N- (benzoyloxycarbonyloxy) succinimide in dimethylformamide, after which the resulting product (32. Further removal of two ben- zyloxycarbonylamine protective groups in the traditional manner, via hydrogen reduction using a palladium on carbon catalyst, forms the desired amikacin (32. Amikacin is highly effective with respect to Gram-negative microorganisms (blue-pus and gastric bacilli, rabbit fever, serratia, providencia, enterobacteria, proteus, salmonella, shigella), as well as Gram-positive microorganisms (staphylococci, including those that are resistant to penicillin and some cephalosporins), and a few strains of streptococci. In the first stage of synthesis, reacting sisomicin with acetaldehyde in a specific acidic medium of pH 5 is successful in selectively giving an imine at the 3-amino group of the 2-deoxystreptamine region of the molecule. The result- ing imine is then hydrogenated by sodium cyanoborohydride to an ethylamino derivative —netilmicin (32. Antibiotics shigella), as well as a few Gram-positive microorganisms (staphylococci and a few strains of streptococci). It is used for severe bacterial infections that are caused by microorganisms sensitive to the drug. Lincosamides bind with the 50 S ribosomal subunit of bacteria and inhibit protein synthesis. Lincosamides are bacteriostatic antibiotics; however, when they reach a certain level in the plasma, they also exhibit bactericidal action against some bac- teria. Lincosamides are highly active against anaerobic infections such as Peptococcus, Peptostreptococcus, Actinomyces, Propionibacterium, and Clostridium fringens, a few types of Peptococcus and Clostridium. Resistance to lincosamides can occur because of the inability of drugs to permeate through the cellular membrane of bacteria, or because of changes in the ribosomal-binding regions. Lincosamides are most often used for treating anaerobic infections such as intraabdom- inal and female infections. Lincosamides are a good alternative to beta-lactam antibiotics for treating infections caused by S. It is useful in treating osteomyelitis and septic arthri- tis because of the large concentration attainable in the bones. It is used for serious bacterial infections: sepsis, osteomyelitis, septic endocarditis, pneumonia, pul- monary abscess, infected wounds, and purulent meningitis. Lincomycin is a reserve drug for infections caused by strains of staphylococci and other Gram-positive microorganisms that are resistant to penicillin and other antibiotics. When using a synthetic racemic mixture without having previously separated it into D- and L-threo forms, it is called sintomycin. The first begins with 4-nitroacetophenone, which is brominated with molecular bromine to make ω-bromo-4-nitroacetophenone (32. The resulting aminoketone is acylated with acetic anhydride to make ω-acetamido-4-nitroacetophenone (32.

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She prescribes it to people in her practice who feel overwhelmed purchase gasex 100 caps with visa, tense effective gasex 100caps, or anxious buy gasex 100 caps amex, yet don’t meet the rigorous criteria that clinicians use to diagnose major depressive disorder or generalized anxiety disorder. I favor ashwagandha, because it is less sedating than other ginsengs, for women with anxiety and/or sleep issues. Fortunately, ashwagandha may be used safely with antidepressants if you are already taking one, which is not true for other herbal therapies such as St. I caution you that if you are on an antidepressant or other medication for mental health, you should consult your doctor before adding an herbal supplement. Relora is an herbal combination that has been shown to reduce evening cortisol and stress- related eating, but only in overweight and obese women. Rhodiola is a plant used in Asian and eastern European traditional medicine to enhance physical and mental performance, stimulate the nervous system, fight depression, and improve sleep. In one study that included both sexes, rhodiola was shown to have an effect on stress- related fatigue, including improved mental performance and concentration, and decreased cortisol levels. She lives in Florida, and I’m flying back and forth from California to see her at least once a month. I want to be there, but it’s incredibly sad and a burden to be so far away, with unhelpful siblings. She’s an avid exerciser; she likes to run in the hills near her home for four miles at a stretch and attends a weekly yoga class. When I tested her cortisol, it was high in the morning: normal is 10 to 15 mcg/dL, and Lily’s was 27 mcg/dL. Treatment protocol: Lily had a history of a blood clot in her leg, so I didn’t want to prescribe estrogen for the hot flashes and night sweats. She started taking 500 mg per day of Korean red ginseng from her local health food store. She added a calming yoga sequence to her day (Yin Yoga), which she could practice at home, twice a week. Results: Within two weeks of starting the protocol, Lily’s mother died of metastatic cancer. Lily mentioned a favorite quote from William Faulkner: “Given a choice between grief and nothing, I’d choose grief. It takes about three days for your hormones to return to baseline after treatment. This suggests that by taking a small dose of cortisol, you may be able to actually calm down your adrenals, perhaps by overriding the pattern of overactivity, and reset the balance. However, I don’t believe the risks outweigh the benefits when there are so many less risky and proven approaches (Step 1 and Step 2 of The Gottfried Protocol). Higher doses may cause hair loss, greasy skin and hair, and possibly breakouts with cystic acne. Some chiropractors and naturopathic physicians hand out glandular supplements like candy, claiming that dried pulverized adrenal and pituitary glands of animals can adjust cortisol levels. But searching the medical literature going back to the 1950s, and reviewing the findings of Hans Selye, who popularized modern stress research, I could find no rigorous data in humans to support this practice. Although many of my clients swear by their glandulars, I do not feel we have sufficient evidence or safety data to prescribe glandulars for high cortisol. Treatment protocol: I self- prescribed a softgel of fish oil (4,000 mg/day), phosphatidylserine (400 mg/day), and rhodiola. Although my salivary cortisol started to come closer to the normal range, it remained high in the morning, especially with consumption of caffeine. So I gave up caffeine and joined a meditation group to provide more structure and accountability. As I became more comfortable with meditation, I noticed that a key feature of stress- crazed overwhelm is that it robs me of discernment. In other words, when I was overwhelmed, my external circumstances did not change, but it felt like they did. It felt to me as if my husband was more critical and annoying, my kids, more demanding. I learned that I find the correct dose of meditation to get to insight; twenty minutes is my sweet spot. Even though it often feels as though the stressors are external, with time and wisdom I’ve determined that the locus of control is internal when it comes to stress response. I try to choose how I respond to stressors rather than going into amygdala hijack. I’ve learned that contemplative practice is a nonnegotiable aspect to my day: it has improved my attention, made me more mindful of what I eat— which helped lead to a 25- pound weight loss—and given me a deeper sense of real choice during my day. I am more patient with my kids, better organized, happy in my work, and more joyful overall. Yes, I still lose my cool, but I’ve become far more skillful at what was clearly my Achilles’ heel: high cortisol and the roller- coaster ride it can take you on. I understood what William James meant by “The greatest discovery of any generation is that a human can alter his life by altering his attitude. I taught myself how to uplevel and downlevel my nervous system more consciously and expertly. Part B: The Gottfried Protocol for Low Cortisol As mentioned in The Gottfried Protocol for High Cortisol, the following solutions are for informational and educational purposes only. Start first with the lifestyle resets, and consult a physician about the advisability of applying further approaches to your symptoms or medical condition, particularly herbal therapies such as licorice, which may cause blood pressure to rise excessively. Step 1: Targeted Lifestyle Changes and Nutraceuticals Get some exercise, perhaps African dance. A fascinating study of college students compared mood and cortisol levels before and after they attended one of three ninety- minute classes: yoga, African dance, or a biology lecture. African dance raised cortisol and mood, yoga lowered cortisol and raised mood, and the lecture changed neither mood nor cortisol. Before I began medical school, I was a bioengineer, and my best friend, who happened to be a rocket scientist, was a remarkably calm woman who never seemed to get stressed out like me. She had a great way of approaching problems, which I call the modular approach: she would take a problem and, rather than trying to solve the whole gigantic hairy thing at once, break it down into component parts, or modules. The interesting backstory to adrenal healing is that much of the research on antistress effects of nutrients and herbs was conducted by Soviet researchers in the 1970s (and are published in Russian). One study showed that a combination of vitamin C (200mg three times per day) plus an intravenous combination of vitamins B1 and B6 restored cortisol production and diurnal rhythm. Step 2: Herbal Therapy Botanical therapies that are proven to raise cortisol include the following: Licorice (Glycyrrhiza). One study of children of women who consumed varying amounts of licorice found that the more licorice the moms consumed, the higher the children’s cortisol levels. Consider deglycyrrhizinated licorice, a capsule or chewable tablet with the chemical bits removed that raise blood pressure. I generally recommend that people with low cortisol try a small dose of root extract: 600 mg, standardized to 25 percent (150 mg) glycyrrhizic acid—and check their blood pressure with a home device and at their local doctor’s office. In patients with Addison’s disease, licorice and grapefruit juice have been shown to raise cortisol levels. In one study, licorice raised median cortisol serum levels and urinary cortisol, whereas grapefruit juice significantly raised serum cortisol. This makes me nervous because any adrenal support should be given extremely cautiously and with an entire whole-foods and lifestyle adjustment for sustained results. In other words, you need the foundation of nutrient-dense whole foods (not processed foods, and especially not refined carbohydrates, which worsen adrenal problems), restorative sleep, and supplements to fill nutritional gaps before resorting to a quick-fix prescription pill. Furthermore, if you take external cortisol for more than a few months, you could develop secondary adrenal insufficiency. If you still suffer with the symptoms listed in the questionnaire despite trying Step 1 and Step 2 of The Gottfried Protocol (pages 116–118), I strongly encourage you to ask your doctor to test your cortisol. If your serum, salivary, or urinary cortisol is low, then consider the bioidentical cortisol in Isocort, an adrenal- support pill from Bezwecken in which the cortisol is derived from fermented plants. The recommended dose is one or two pills up to three times a day—not to exceed six pills a day—taken with a meal. As with high cortisol, I do not recommend supplements derived from animal glands for similar reasons. Signs of Cortisol Balance When your level of cortisol is appropriate and not turning your brain into Swiss cheese, you feel calm, cool, and collected most of the time.

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The former symptoms indicate that the antipsoric has taken hold of the root of the evil buy gasex 100caps with visa, and will do much for its thorough cure 100 caps gasex amex, but the latter discount gasex 100 caps fast delivery, if they appear more frequently and more strongly, give the physician a hint that the antipsoric was not selected quite homoeopathically, and should be interrupted in time and replaced by a more appropriate one. The cito, tuto et jucunde (quickly, safely and pleasantly) of Celsus, the patient may reasonably ask from his physician, and from the homoeopath he can rightly expect this in acute diseases springing from occasional causes, as well as in the well-defined intermediate diseases prevalent at times (the so-called intercurrent diseases). The cure of great chronic diseases of ten, twenty, thirty and more yearsÕ standing (if they have not been mismanaged by an excess of allopathic treatments, or indeed, as is often the case, mismanaged into incurableness) may be said to be quickly annihilated if this is done in one or two years. If with younger, robust persons this takes place in one-half the time, then on the other hand in advanced age, even with the best treatment on the part of the physician and the most punctual observance of rules on the part of the patient and his attendants, considerable time must be added to the usual period of the cure. It will also be found intelligible that such a long-continued (psoric) chronic disease, the original miasm of which has had so much time and opportunity in a long life to insert its parasitical roots as it were, into all the joints of the tender edifice of life, is at last so intimately interwoven with the organism that even with the most appropriate medical treatment, careful mode of life and observance of rules on the part of the patient, great patience and sufficient time will be required to destroy this many armed polypus in all its parts, while sparing the independence of the organism and its powers. What does he risk, if as a matter of course, his treatment only aggravates the disease? The strength increases during the whole of the cure without the use of the so-called tonics, and the patients joyously rise up again of themselves in proportion as their life is delivered from its corroding enemy. The medicine in the numbered paper (as also all that succeed) if it is desired that it should act but feebly, should be taken dry and allowed to dissolve on the tongue, or be moistened with two or three drops of water on a spoon, and by itself, without in either case drinking anything after it or eating anything within half an hour or a whole hour. He must avoid during this hour, as indeed throughout the treatment, all disagreeable excitement, nor should he strain his mind immediately after taking the dose, in any way, either by reading or computing, by writing, or by conversations requiring meditation. The amara which they give between, together with the quinine, without being able to supply the strength lost, only add new evils. If he orders the solution taken in one or three days it must be stirred up not only the first time, but also the other two times, by which every part thus stirred acquires another somewhat higher degree of potency, and so is received more willingly by the vital force. To direct the use of the same solution for a greater number of days is not advisable, as the water, kept longer, would begin to putrefy. How a dose for smelling may be adapted to all degrees of strength, I have mentioned above. But in case the menses previously have been premature or too profuse, or two long-lasting, it is often necessary to give on this fourth day a small dose of nux vomica (one very small pellet, moistened with a high dynamization) to be smelled, and then, on the fourth or sixth day following, the antipsoric. But if the female is very sensitive and nervous, she ought, until she comes near her full restoration, to smell such a pellet once about every time seventy-two hours after the beginning of her menses, notwithstanding her continued antipsoric treatment. In this state of woman, which is quite a natural one, the symptoms of the internal psora are often manifested most plainly** on account of the increased sensitiveness of the female body and spirit while in this state; the antipsoric medicine therefore acts more definitely and perceptibly during pregnancy, which gives the hint to the physician to make the doses in these as small and in as highly potentized attenuations as possible, and to make his selections in the most homoeopathic manner. In what more reliable way could the states of the womb, which are not infrequently dangerous, and sometimes fatal even in a proper presentation of the foetus and in a natural labor, be removed in advance than by a timely antipsoric treatment during pregnancy? Even the improper presentation of the child has, if not always, still very often its only cause in the psoric sickness of the mother, and the hydrocephalus and other bodily defects of the child have surely this cause! Only the antipsoric treatment of the sickly wife if not before, at least during pregnancy, can remove in advance the motherÕs inability for suckling, as also in suckling prevent the frequent sore breasts, the soreness of the nipples, the frequent inclination to erysipelatous inflammations of the breasts and their abscesses, as well the haemorrhages of the uterus during suckling. And with such cases this time of pregnancy may very well be made use of for antipsoric treatment, which in such a case is directed against the symptoms of the morbid state before pregnancy, so far as this can be remembered. The corporeal nature (called the life-preserving principle or vital force) when left to itself, since it is without reason, cannot provide anything better than palliatives in chronic diseases and in the acute diseases springing thence which cause sudden danger to life, owing to the indwelling psora. These are the causes of the more frequent secretions and excretions of various kinds taking place of themselves now and then in chronic (psoric) diseases, as e. All these are attended with only temporary alleviations of the chronic original malady, which owing to the losses of humors and of strength thereby only becomes more and more aggravated. Allopathy has, so far, not been able to do any more than this toward a genuine cure of the chronic diseases; it could only imitate the unreason in corporeal nature in its palliatives (usually without an equal alleviation and with a greater sacrifice of strength). It caused therefore, more than the other, a hastening of the general ruin, without being able to contribute anything to the extinction of the original malady. To this class belong all the many, indescribable purgatives, the so-called dissolvents, the venesection, cupping, the applying of leeches now so insanely frequent, the sudorifics, the artificial sores, setons, fontanelles, exutories, etc. God be praised, the homoeopathic physician who is acquainted with the means of a radical cure, and who thus through the anti-psoric treatment can destroy the chronic disease itself, has so little need of the above mentioned applications, which only hasten dissolution, that he has on the contrary to use all care that the patient may not secretly use some of these appliances, following the old routine, diffused over the whole earth by allopathy. Only journeymen, half homoeopaths still, I am sorry to say, use such a contradictio in adjecto (weakening while desiring to cure). Rarely a third injection will be needed, after waiting a third quarter of an hour. This help which acts chiefly mechanically by expanding the rectum, is harmless when repeated after three or four days if it is necessary, and, as before mentioned, only at the beginning of the treatment - for the antipsoric medicines, among which in this respect lycopodium next to sulphur has the pre-eminence, usually soon remove this difficulty. The inexcusable wasting fontanelles the homoeopathic physician must not at once suppress, if the patient has had them for some time (often for many years), nor before the antipsoric treatment has already made perceptible progress, but if they can be diminished without totally stopping them, this may safely be done even in the beginning of the treatment. So also the physician should not at once discontinue the woollen underclothing, which is said to prevent the taking of cold and the recommendation of which is carried very far by the ordinary physicians in default of any real assistance. Though they are a burden to the patient, we should wait until there is a visible improvement effected by the antipsorics which remove the tendency to taking cold, and until the warmer season comes. With patients who are very weakly, he should in the beginning change to cotton shirts which rub and heat the skin less, before requiring patients to put linen underclothing on their skin. Is it laziness or a haughty preference for their old (although ruinous) allopathic routine, or is it lack of love for their fellowman which prevents a deeper entering into true, beneficent Homoeopathy and an elevation into the troublesome but correct and useful selection of the remedy homoeopathically specific in every case, and into that mastery of Homoeopathy now no more rare? So-called warm and hot baths for the sake of cleanliness, to which spoiled patients are usually very much attached, are not to be allowed, as they never fail to disturb the health; nor are they needed, as a quick washing of a part or of the whole of the body with lukewarm soap-water fully serves the purpose without doing any injury. At the end of these directions for treating chronic diseases, I recommended, in the first edition, the lightest electric sparks as an adjuvant for quickening parts that have been for a long time paralyzed and without sensation, these to be used besides the antipsoric treatment. I am sorry for this advice, and take it back, as experience has taught me, that this prescription has nowhere been followed strictly, but that larger electric sparks have always been used to the detriment of patients; and yet these larger sparks have been asserted to be very small. I, therefore, now advise against this so easily abused remedy, especially, as we can easily remove this appearance of enantiopathic assistance; for there is an efficient homoeopathic local assistance for paralyzed parts or such as are without sensation. This is found in cold water * locally applied (at 54û Fahrenheit) from mountain-springs and deep wells; either by pouring on these parts for one, two or three minutes, or by douche-baths over the whole body of one to five minutes duration, more rarely or more frequently, even daily or oftener according to the circumstances, together with the appropriate, internal, antipsoric treatment, sufficient exercise in the open air, and judicious diet. The medicines which have been found most suitable and excellent in chronic diseases so far, I shall present in the following part according to their pure action on the human body, as well those used in the treatment of the diseases of psoric origin, as those used in syphilis and in the figwart- disease. That we need far fewer remedies to combat the latter than the psora can not with any thinking man form an argument against the chronic miasmatic nature of the latter and still less against the fact that it is the common source of the other chronic diseases. The psora, a most ancient miasmatic disease, in propagating itself for many thousands of years through several millions of human organisms, of which each one had its own peculiar constitution and was exposed to very varied influences, was able to modify itself to such a degree as to cause that incredible variety of ailments which we see in the innumerable chronic patients, with whom the external symptom (which acts vicariously for the internal malady), i. Hence it seems to have come to pass that this half-spiritual miasma, which like a parasite seeks to inroot its hostile life in the human organism and to continue its life there, could develop itself in so many ways in the many thousands of years, so that it has even caused to spring forth and has born modified offshoots with characteristic properties, which do not indeed deny their descent from their stock (the common psora) but, nevertheless, differ from one another considerably by some peculiarities. These changes are due in some part to the varying physical peculiarities and climatic differences of the dwelling-places of men afflicted with the psora,* and in part are moulded by their varying modes of life, e. And so also the other great varieties in the mode of living and in the occupations of men with their inherited bodily constitutions give to the psoric diseases so many modifications, that it may easily be understood, that more numerous and more varied remedies are needed for the extirpation of all these modifications of the psora (antipsoric remedies). But there can be no such external visible marks in them; nevertheless while proving several powerful substances as to their pure effects on the healthy body, several of them by the complaints they caused showed me their extraordinary and manifest suitableness for homoeopathic aid in the symptoms of clearly defined psoric diseases. Some traces of their qualities leading in this direction gave me in advance some hint as to their probable usefulness; e. The circumstance that some haemorrhages have been arrested by large doses of salt was another hint. So was the usefulness of Guaiacum, Sarsaparilla and Mezereum, even in ancient times where venereal diseases could not be healed by any amount of mercury unless one or the other of these herbs had first removed the psora complicated with it. As a rule it was developed from their pure symptoms, that most of the earths, alkalies and acids, as well as the neutral salts composed of them, together with several of the metals cannot be dispensed with in curing the almost innumerable symptoms of psora. The similarity in nature of the leading antipsoric, sulphur, to phosphorus and other combustible substances from the vegetable and the mineral kingdoms led to the use of the latter, and some animal substances naturally followed them by analogy, in agreement with experience. Still only those remedies have been acknowledged as antipsoric whose pure effects on the human health gave a clear indication of their homoeopathic use in diseases manifestly psoric, confessedly due to infection; so that, with an enlargement of our knowledge of their proper, pure medicinal effects, in time it may be found necessary to include some of our other medicines among the antipsoric remedies; although even now we can with certainty cure, with the antipsorics now recognized, nearly all non-venereal (psoric) chronic diseases, if the patients have not been loaded down and spoiled through allopathic mismanagement with severe medicine-diseases, and when their vital force has not been depressed too low, or very unfavorable external circumstances make the cure impossible. Nevertheless, it need not be specially stated that the other proved, homoeopathic medicines, not excepting mercury, cannot be dispensed with in certain states of the psoric diseases. Some of these medicines in their crude state seem to have a very imperfect, insignificant medicinal action (e. Other substances, on the other hand, in their crude state are, even in the smallest quantities, so violent in their effects that if they touch the animal fibre, they act upon it in a corroding and destructive manner (e. The changes which take place in material substances, especially in medicinal ones, through long-continued trituration with a non-medicinal powder, or when dissolved, through a long-continued shaking with a non-medicinal fluid, are so incredible, that they approach the miraculous, and it is a cause of joy that the discovery of these wonderful changes belongs to Homoeopathy. Not only, as shown elsewhere, do these medicinal substances thereby develop their powers in a prodigious degree, but they also change their physico-chemical demeanor in such a way, that if no one before could ever perceive in their crude form any solubility in alcohol or water, after this peculiar transmutation they become wholly soluble in water as well as in alcohol - a discovery invaluable to the healing art. The brown-black juice of the marine animal Sepia, which was formerly only used for drawing and painting, is in its crude state soluble only in water, not in alcohol; but by such a trituration it becomes soluble also in alcohol. The yellow Petroleum only allows something to be extracted from it through alcohol when it is adulterated with ethereal vegetable oil; but in its pure state while crude it is soluble neither in water nor in alcohol (nor in ether).

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